MEDICARE: KATIE JACOBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175M00000X	Lay Midwife

General Provider Information

NPI Number	:	1861641664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE JACOBS

Provider Business Mailing Address
First Line	:	6650 DANA ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-1110
Country	:	US
Telephone Number	:	510-684-4867
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 DANA ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-1110
Country	:	US
Telephone Number	:	510-684-4867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	09/29/2008

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Directions to “ KATIE JACOBS ” Practice Location

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